Blockchain – New Challenges and Opportunities for Health

May 29, 2018

The healthcare industry is now collecting record amounts of data.  What are factors limiting the use of this information and how might they be impacted by Blockchain technology?

As the world of technology and the Internet of Things continues to progress at a rapid pace, the amount of data being collected continues to increase wildly.  From the websites we visit as individuals to the tire sensors on an entire fleet of commercial vehicles, vast amounts of detailed data is now generated and collected in nearly every aspect of our modern lives.  In some areas, it is very easy to see how this data is being utilized – for instance, the websites an individual visits will often impact the ads they are shown on other websites.  The healthcare industry is being flooded with data from dozens of different sources, both new and old.  Compared to other industries, however, healthcare is by nature much more heavily regulated, sensitive and high profile. This in turn, among other things, has somewhat limited the uses of these large, new sets of data.

In recent years, a new type of technology has been developed called Blockchain and this development could truly be a game changer for healthcare and health data.  Not only does Blockchain have several basic features that will help to overcome many of the risks that exist with large amounts of personal health data, but it also has several features that will enable the healthcare industry to use the increasingly massive amounts of data now available to a level much closer to its full potential.

Exactly what is Blockchain?

You’ve probably heard most about Blockchain through cryptocurrencies, such as Bitcoin.  Although Blockchain was conceived originally for cryptocurrencies, several of the basic tenants of the technology make it a good fit for uses outside of currencies.

At its core, Blockchain is a distributed and decentralized transactional ledger that collects and stores records in near real time.  A network of computers called nodes or miners work together to verify transactions using complex algorithms.  However, one node is not responsible for this verification – there must be a majority consensus among the nodes that the records are valid in order for them to be added.  Verified blocks of records are linked together with a cryptographic validation function, creating a chain of multiple blocks, hence the name Blockchain.  The nodes each maintain a replica of the shared database, meaning that no single entity has the only copy of the information.

The data within the Blockchain is available to all who have access, but is not changeable.  This allows a wide variety of users access to the same set of data without compromising security and integrity.  This high level of security comes predominately from the fact that the blocks are linked together with the validation functions – data in one block cannot be altered after the fact without forcing an alteration of each of the subsequent blocks, which would require a consensus among the majority of the nodes that the changes are valid.  Forcing a consensus among nodes when a transaction is not valid is prohibitively difficult, even for the most sophisticated hackers.

Blockchains can be set up with open or restricted access as well as public and private key combinations to encrypt and decrypt the data.  In fact, by adding certain features into the algorithms and validation rules, the technology can enforce access restrictions automatically as well as provide notifications of non-compliant access or use of the information.

Although Blockchain was originally developed for records of current transactions between parties, it is not limited to this usage.  Because many of the health records can be considered transactions between two or more parties, healthcare industry data often fits into the Blockchain structure relatively easily.

The Current Challenges of Healthcare Data

The healthcare industry is now collecting record amounts of data, and theoretically this information could be used in many different ways.  However, there are several factors currently limiting the use of this information.

Regulatory Concerns: Predominately due to regulatory and privacy issues, the sharing of health data between entities is quite difficult and still limited.  For example, the risks of sharing protected health information data are still quite large – a single breach of the law can bring severe monetary fines in addition to negative public relations and harm to consumers.

Inaccessible and Imperfect Information: The health industry is currently using a centralized structure for data storage and collection – each entity has control of its own data and stores and maintains that data independently.  This structure was selected on purpose – due to the level of security and sensitivity around health data and the available technology to protect the data, a centralized structure was, and still remains, one of the safest manners of storage.  However, this structure does create some issues.

Because each entity collects and stores its data separately, data is bifurcated across the system, stored in different manners and formats.  Additionally, different entities have different rules for what data elements they will and won’t collect, store and share.  This makes combining data from different sources quite difficult and inefficient.  For example, if patients see multiple physicians or specialists, often times they are not all part of the same health system using the same data storage techniques and sharing schemes and each individual doctor will not be able to easily see the patients’ health history.  Even if they do get access to some of the records, due to the level of regulatory concerns and security arrangements that must be made between different entities, they may be time lagged or partially complete.

Medical and clinical researchers also struggle to gain access to data to perform their studies.  For instance, if clinical trials have been performed in another setting and produced useful data, it still may not be easily accessible to a different researcher who could use the information.  This is because of our system structure, security needs and bifurcation.  This limitation reduces collaboration across the industry and this directly impacting innovation and improvement in treatment protocols and patient care.  

Fraud: The centralized structure makes verification of data difficult and opens the door for data to be hacked, stolen and/or corrupted.  Verification of data is expensive and time consuming and in fact several companies in the healthcare space use clearing houses to assist in this task.  Additionally, because of the centralized structure, a cyber-attack can be perpetuated on a single entity holding data – these attacks can be difficult to catch early because they are isolated and can be detrimental as there is no other entity with a verified copy of the information.

The challenges listed above are not exhaustive by any means, but it can be said that the limits of our current data structure are predominately driven by security concerns and strict regulation.  These limitations have an impact on all within the healthcare industry – from patients and physicians, to clinical researchers and analysts at insurance companies.

How can Blockchain Help?

Although use is in its infancy in the healthcare industry, the basic structure of Blockchain technology brings several benefits that can tackle many restrictions of our current scheme.

Increased Security and Sharing: Due to the decentralized structure, public/private key encryption, and the high level of verification that occurs prior to records being added to the chain, the data is very secure – the network of nodes each maintain a copy of the database and all of the records are time stamped and cannot be tampered with after the fact.  This means that it is much more difficult for data to be corrupted or stolen. Even if one node is corrupted, verified copies of the data will exist elsewhere.  This ability to have more secure data and share data more securely will cut down on costs and improve access to data across the health system.  For example, this means that doctors will more easily be able to see the entire health record for their patient to provide them more holistic care. 

Improved Collaboration and Innovation:  With more access to verified data that is safely shared, some of the limits to innovation and collaboration between entities will be removed.  Researchers could gain additional insights from existing data, and those running clinical trials will be able to publish the protocols and data from their work.  Additionally, smaller companies that found managing their own large data set resource prohibitive will be more easily able to enter the industry as they will no longer need to maintain their own large storage and computing facilities.

Real Time Data and Verification: The infrastructure of Blockchain essentially provides an audit chain for any record.   Not only does this make verification of data much easier and more efficient, saving costs, but it also enables new uses of information that are currently not in the foray.  For example, we could use Blockchain to store records on a bottle of pills from its creation to its use, cutting down on counterfeit medicine reaching the consumer system.  Additionally, because everything is done in near real time, those using data will be able to access much more real time results rather than utilizing data that has a several month lag.

Reductions in Waste and Unnecessary Cost: With access to Blockchain, costs of care and consumer costs can more easily be predicted to help make more informed decisions.  Blockchain can be enabled to view a specific procedure through the lens of a given healthcare policy benefit structure and provider-payer contracted cost arrangements – this can help consumers and providers understand which facilities may have a better price or which benefit plan would be most appropriate for any given patient and their specific needs.  Similarly, the payments and adjudication of healthcare claims can be much more easily automated with the use of the Blockchain system, reducing cost and improving processing speed.

Enhanced Predictive Analytics: With the ability to access extremely large sets of data on a Blockchain, predictive analytics work can be performed more readily and easily.  This ability to better predict health outcomes and costs has several uses.  For instance mechanisms can be developed to alert a physician that a patient has a combination of diagnostic codes from various entities that have a risk of leading to a much more severe health event.  Predictive analytics can also help insurance companies and providers better focus their resources on the patients that are most likely to need their assistance in the future, with the aim of preventing the adverse health event.

Increased Uses for New Data: Blockchain within healthcare could enable the conjoining of multiple different types of data sets that are not currently being used extensively.  A common example would be that heart rate data from an individual’s smart watch can be reviewed by a doctor in conjunction with their standard lab work during an annual physical or enable a physician to perform real-time monitoring of a health condition from afar without seeing their patent or sending them to a lab.

These are certainly not the only benefits a Blockchain structure could provide to the healthcare industry and as the technology is explored, even more capabilities will be discovered.

It is clear that Blockchain could have widespread positive implications for safety, effectiveness, security of information and the movement toward value based care.  There will need to be careful planning and consideration among all of the parties involved for Blockchain implementation to reach its full potential.  Particularly, regulatory bodies will need to support the adoption of the technology among the industry and different entities that traditionally compete against each other will need to collaborate in the development of the overall structure and framework of the technology.  There are still many unanswered questions and concerns and rightfully so.  However, the opportunities that the use of Blockchain could provide to the healthcare industry are vast.   It will be exciting to watch as its use matures and spreads across the industry.

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